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The breathing circuit may be open, closed, or semi-closed, depending on whether breathing gas is recycled. A closed or semi-closed circuit will include components which remove carbon dioxide from the exhaled gas and add oxygen before it is delivered for inhalation, so that the mixture remains stable and suitable for supporting life.
Pulmonary compliance is calculated using the following equation, where ΔV is the change in volume, and ΔP is the change in pleural pressure: = For example, if a patient inhales 500 mL of air from a spirometer with an intrapleural pressure before inspiration of −5 cm H 2 O and −10 cm H 2 O at the end of inspiration.
A RSBI score of less than 65 [3] indicating a relatively low respiratory rate compared to tidal volume is generally considered as an indication of weaning readiness. A patient with a rapid shallow breathing index (RSBI) of less than 105 has an approximately 80% chance of being successfully extubated, whereas an RSBI of greater than 105 virtually guarantees weaning failure. [4]
Proportional assist ventilation is a mode in which the ventilator guarantees the percentage of work regardless of changes in pulmonary compliance and resistance. [13] The ventilator varies the tidal volume and pressure based on the patients work of breathing, the amount it delivers is proportional to the percentage of assistance it is set to give.
Tidal volume is measured in milliliters and ventilation volumes are estimated based on a patient's ideal body mass. Measurement of tidal volume can be affected (usually overestimated) by leaks in the breathing circuit or the introduction of additional gas, for example during the introduction of nebulized drugs.
The most common parameters measured in spirometry are vital capacity (VC), forced vital capacity (FVC), forced expiratory volume (FEV) at timed intervals of 0.5, 1.0 (FEV1), 2.0, and 3.0 seconds, forced expiratory flow 25–75% (FEF 25–75) and maximal voluntary ventilation (MVV), [10] also known as Maximum breathing capacity. [11]
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